Summary points Despite the relevant information that postmortem examinations can provide, autopsy rates have been declining worldwide in the last few decades. Autopsies are especially necessary in low-income countries, where reliable information on cause of death is much more limited and in vivo clinical diagnosis is hampered by the scarce availability of diagnostic tools. The use of the autopsy or of robust substitutes for this procedure needs to be encouraged as a mechanism for the continuous improvement of clinical diagnosis and as a complement for cause-of-death investigation and surveillance.